Running head: PERSONAL PHILOSOPHY PAPER 1

Bethany Porter

Personal Philosophy Paper

Synthesis for Nursing Practice

NUR4142

October 16, 2017

Dr. Christine Turner

I pledge
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Personal Philosophy Paper

What is nursing?

The answer to is question is one that has evolved many times since I started nursing

school three and a half years ago. This answer seems to change on a weekly basis as I am

still picking up nuances and complexities of nursing that I didnt even know existed. It

changed yet again last week, when my preceptor in clinical immersion successfully

diagnosed a complicated case of Shingles before the physician even put eyes on the

patient.

At this point in my education and experience, my definition of nursing is this: a

medical profession in which your job is to provide quality, holistic care for your

patient(s). On a daily basis, this means you interact with, assess, reassure, treat, advocate

for, re-assess, and connect with your patient in a way that shows compassion, and helps

them feel valued and their concerns heard. Nurses should communicate effectively with

their team of physicians, pharmacists, specialists and case-managers; should delegate

tasks when it is the safest practice, and should be willing to jump in and help their peers

when theyre drowning. We use our knowledge and experience to provide good service to

those who need it.

The Bon Secours Memorial College of Nursing has a mission and philosophy that I

am proud to work under. I feel that my personal definition of nursing is accurately

represented in the following tenets of Bon Secours philosophy: Nurses provide holistic

care to promote wellness, prevent disease, restore health, and to provide comfort;

Caring is expressed through application of nursing knowledge in practice, critical

thinking skills, interpersonal skills, assertiveness, curiosity, courage and humor; The
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individual experience is valued and is worthy of inherent dignity and respect, (Bon

Secours Memorial College of Nursing, 2017).

Reflect on Philosophy

While I believe in my definition of nursing, I personally feel like I have yet to

accomplish everything that makes a successful nurse. I get closer to it with every shift of

clinical immersion and I my heart is in the right place, but some parts of the nursing role

will only come naturally with experience. My confidence and skill level in hands-on tasks

such as IV starts, medication administration, foley catheter insertion, etc. have drastically

improved over the past months, and new challenges have appeared in their place.

Assessments, prioritization, communicating with physicians (confidently), and time

management have become my new daily challenges, but I know that as I become

comfortable with those things, they will fade into my subconscious and become things

that I do naturally.

In my daily practice, my current focus is on balancing quality and compassion. As I

mentioned earlier, much of what nursing entails doesnt come naturally to me, so Im

carefully (and often meticulously) completing the necessary tasks that come with each

patient. Because this requires a lot of focus, I often find myself backtracking to have

meaningful interactions with my patients, give them encouraging words, and make sure

theyre comfortable. While I still feel like I have on training wheels, I leave the floor

most days feeling good about the work that Ive done, and self-reflect on what I can do to

further improve my practice.

Example of Nurse-Patient Encounter

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The patient encounter that comes to mind is not one that is medically complicated or

life changing, but it was a situation in which I was able to work with my preceptor to

truly demonstrate what it means (to me) to be a nurse.

The patient came in with his father around 7:30am, and had been experiencing

severe nausea and vomiting for about six hours. He was very dehydrated (which was

reflected in his labs) and looked miserable. My preceptor, Carol, and I didnt have any

other patients, so I was able to take my time to fully assess him, identify any previous

health conditions, gather a history of his symptoms, and communicate with the physician

about the plan of care. After starting his IV and taking labs, I administered Zofran, IV

fluids, and potassium (of which he was low), while providing adequate patient teaching

for each. I was able to hear his complaints, reassure him, bring him blankets, and build a

rapport with his family. Within a couple of hours his color had improved, he had energy,

and his vomiting had completely subsided. He and his family happily went home,

thanking Carol and me for our help.

Looking back on it objectively, he was an easy patient with a very treatable

condition and a good disposition. However, when I reflect on it subjectively, it was my

first real opportunity to provide complete care and do so with minimal help from my

preceptor. I assessed, treated, reassessed, and collaborated with my team. I treated him

and his family with loving kindness and empathy. I provided quality, holistic care.

Finally, I truly felt like a nurse! After he left, the pace of the ED picked up and none of

the patient interactions I had for the rest of the day went as smoothly as that one.

However, I had confidence and joy knowing that it was possible to provide complete

nursing care that I was proud of.

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Values and Beliefs

When I first started nursing school, I put a lot of value into compassion and

integrating faith into my care. I drew a lot of inspiration from the Caritas process, and

focused on cultivating relationships that promoted healing, kindness, grace and dignity. I

recognized the role of science in nursing and the value of evidence-based practice, but

didnt have enough exposure to the full scope of nursing to really understand its

necessity.

My values have evolved in such a way that has allowed me to have a more realistic

view of nursing. The more I learned about the human body, it became clearer to me that

in all of its complexities, our bodies can be very predictable. Once we understand how

each system works together, we can better predict how they will respond to certain

conditions, or analyze a persons symptoms to select a diagnosis. The nurses role in

assessing and monitoring a patients conditions is integral in the process of bringing

someone back to health. Yes, compassion is an important part of nursing but without a

solid foundation of knowledge, research, and critical-thinking skills, its impossible to

provide the best-possible care to a sick patient.

Describe Benners Theory

Patricia Benners book, From Novice to Expert, is based on the theory that there

are five discernable levels of competency in nursing. She examines the differences

between practical and theoretical knowledge in nursing, and illustrates each point with

stories and experiences from old and new nurses. She then uses this information to

develop ways of preserving and expanding knowledge.

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The five levels are Novice, Advanced Beginner, Competent, Proficient, and Expert.

Each is largely categorized by the individuals amount of experience (i.e. a brand new

nurse would be considered a novice, and a veteran nurse is often an expert); however, she

does clarify that ones time on the floor doesnt always equate to a higher skill level.

While the first three levels are generally achieved by comfort and familiarity with the

day-to-day tasks of nursing, the last two levels are dependent on ones ability to push past

the rules and guidelines and use past experiences to shape the way they critically think.

Benner often references to the Dreyfus Model of Skill Acquisition in her explanation

of transitioning to an Expert nurse. This model maintains that, as we gain more

knowledge of whatever it is were trying to master, we must learn (over time) to

disengage and make decisions unconsciously. It goes as far as to say that an experts

performance can actually deteriorate if they continue to pay too close attention to the

rules and guidelines that defined their performance at the Novice level.

To illustrate this theory, Benner provided examples that had two nurses perception

of the same situation. The expert nurse recalled an incident in terms that were simple and

straightforward, and demonstrated her quick thinking in treating the patient. The novice

nurse, on the other hand, provided a lot of extraneous detail that took away from the

actual situation at hand, and even prolonged his ability to quickly intervene. While they

both arrived at the same conclusion, the expert was able to act quickly without getting

caught in the technicalities of problem solving. Her past experiences granted her the

freedom of simply knowing what to do next (Benner, P. 2001).

Describe the Skill Acquisition Stage

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At the end of every clinical immersion shift, I spend my 25-minute commute home

reflecting on my day. Things that I did well, things that didnt go so well, things that I

had no control over, things my preceptor did that I did/didnt understand, etc. I dont have

very much grace for myself when I make mistakes, so most of it is often spent going over

a particularly stressful or frustrating situation that I didnt handle well. While this might

not be the most positive way to decompress, I feel that its made me cognizant of my

successes and shortcomings, and a good judge of where I am.

Though Ive not yet finished nursing school, I feel like I have about the same

amount of nursing experience as a new graduate whose nursing program mightve been

shorter or with less clinical opportunities. Ive worked in the hospital setting as a CNA

for five years, so I have familiarity with patient interaction and basic hands-on skills.

Based on those things, I would describe myself as an Advanced Beginner.

Benner describes Advanced Beginners as individuals who can demonstrate

marginally acceptable performance, [who] have coped with enough real situations to note

(or to have pointed out to them by a mentor) the recurring meaningful situational

components that are termed aspects of the situation. According to Benner, aspects

require prior experience in actual clinical situations for recognitions [and] include

overall, global characteristics that can by identified only through prior experience

(Benner, P. 2001). Since I have less than a year of real nursing experience, I am limited

in my knowledge. However, since I have had enough experiences to draw from and assist

in my practice, I feel I am above the level of Novice.

State Three Things

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Based on Benners theory, the path to moving forward in nursing will rely greatly on

my future experiences and my continued growth. Because of that, the first thing I will do

is to simply get a full-time job as a nurse and work. I want to wake up at the crack of

dawn, spend 36 exhausting hours a week on the floor, and come home feeling

accomplished, stretched, and ready for the next day. Ive been pushing myself every day

to make it through the most academically challenging years of my life, and I want to put

that knowledge to good use.

Next, I will continually ask questions. When Im caring for a patient whose illness is

affecting them in a way I dont understand, Im going to research its pathology. If a

doctor orders a test or procedure that confuses me, Im going to ask my peers. Its very

inspiring to me when I see nurses who know protocols by heart and confidently treat their

patients without relying on others to hold their hand. I want to be that nurse someday.

Finally, I will never give up the desire to learn. Once Ive become comfortable with

one aspect of my job, I want to push myself to familiarize myself with others. Whether

its continuing my formal education, pursuing new certifications, or finding a specialty, I

hope to never lose my excitement of learning new things. By never giving myself the

opportunity to be complacent, I can gain both knowledge and experience that will

positively impact my practice.

Conclusion

Some days I feel like Im sitting at the starting line of a race, ready to take off on

this journey that Ive spent years preparing for. As my values and principles have shifted

and grown, I feel like I have a stronger sense of who I am, and what kind of impact I

hope to have on the world. I know that my career path will take me places I wont be
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expecting, and that it wont always be as smooth as I expect it to be. I do believe,

however, that this is my calling, and that someday Ill be the nurse I always hoped to be.
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References

Benner, P. (2001). From Novice to Expert: Excellence and Power in Clinical Nursing

Practice. New Jersey: Prentice Hall.

Bon Secours Memorial College of Nursing, (2017). College Catalog. Page(s) 46-47.